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经皮内镜腰椎间盘切除术与开放腰椎间盘切除术治疗青少年腰椎间盘突出症的比较:回顾性分析。

Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Discectomy in the Treatment of Adolescent Lumbar Disc Herniation: A Retrospective Analysis.

机构信息

Department of Orthopedics, Peking University Third Hospital, Beijing, China.

Department of Orthopedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China.

出版信息

World Neurosurg. 2021 Jul;151:e911-e917. doi: 10.1016/j.wneu.2021.05.007. Epub 2021 May 11.

Abstract

OBJECTIVE

To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation.

METHODS

Clinical data of 257 patients with single-segment adolescent lumbar disc herniation who underwent surgical treatment from January 2015 to December 2019 were retrospectively collected. The patients were divided into PELD and OLD groups based on the surgical method used. Propensity score matching was performed using preoperative baseline data of patients in both groups, and some patients in both groups were selected for comparative study. Clinical and follow-up data were assessed and compared.

RESULTS

There was no statistically significant difference in preoperative baseline data between the 2 groups of patients after propensity score matching. Visual analog scale and Oswestry Disability Index scores improved in both groups postoperatively and at each follow-up time point (P < 0.05). However, visual analog scale scores on the first postoperative day and Oswestry Disability Index scores at 3 months postoperatively were lower in the PELD group than in the OLD group (P < 0.05). Duration of surgery, intraoperative blood loss, and duration of postoperative hospitalization were lower in the PELD group than in the OLD group (P < 0.05). There was no statistically significant difference between the 2 groups when comparing complication and recurrence rates (P >0.05).

CONCLUSIONS

Both PELD and OLD are effective and safe surgical techniques for treatment of adolescent lumbar disc herniation. However, compared with OLD, PELD is more advantageous for rapid symptom relief and improving postoperative quality of life with a low rate of complications and recurrence.

摘要

目的

比较和分析经皮内镜腰椎间盘切除术(PELD)与开放腰椎间盘切除术(OLD)治疗青少年腰椎间盘突出症的疗效和安全性。

方法

回顾性收集 2015 年 1 月至 2019 年 12 月 257 例单节段青少年腰椎间盘突出症患者的临床资料。根据手术方法将患者分为 PELD 组和 OLD 组。采用倾向评分匹配法对两组患者的术前基线数据进行匹配,选择部分患者进行对比研究。评估和比较两组患者的临床和随访资料。

结果

经倾向评分匹配后,两组患者的术前基线数据无统计学差异。两组患者术后及各随访时间点的视觉模拟评分法(VAS)和 Oswestry 功能障碍指数(ODI)评分均较术前改善(P<0.05)。但 PELD 组患者术后第 1 天的 VAS 评分和术后 3 个月的 ODI 评分均低于 OLD 组(P<0.05)。PELD 组患者的手术时间、术中出血量和术后住院时间均短于 OLD 组(P<0.05)。两组患者的并发症和复发率比较差异无统计学意义(P>0.05)。

结论

PELD 和 OLD 均是治疗青少年腰椎间盘突出症的有效且安全的手术方法,但与 OLD 相比,PELD 更有利于迅速缓解症状,提高术后生活质量,且并发症和复发率较低。

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